Personality and Breastfeeding
by Anne Eglash MD, IBCLC, FABM
There is a great deal of evidence that there are certain groups of women who breastfeed less, particularly in those who are younger, less educated, have less income, have less social support, and are in certain racial/ethnic groups. Researchers have also shown that women who are depressed and/or anxious breastfeed less. But what about personalities? What personality characteristics make it easier to deal with the challenges that breastfeeding women face? It can be hard to tease out depression/anxiety from personality traits because some personality traits are more highly associated with depression and anxiety..
Researchers of a large Dutch study of 2927 pregnant women (conducted 2010-2015) sought to investigate the role of personality in breastfeeding duration. They asked their subjects to fill out personality questionnaires, as well as surveys for anxiety and depression. They followed the women throughout pregnancy and for 6 months postpartum, to determine any associations between personality and exclusive breastfeeding (EB) by 6 months. They controlled for age, relationship status, parity, socioeconomic status, and depression/anxiety.
The personality categories, based on the NEO Five Factor Inventory are as follows: 1) agreeable (trust, straightforwardness, altruism, compliance, modesty, tender-mindedness), 2) conscientiousness (competence, order, dutifulness, achievement, self-discipline, deliberation), 3) extraversion (warmth, gregariousness, assertiveness, excitement-seeking, positive emotion), 4) neuroticism (anxiety, hostility, depression, self-consciousness, impulsivity, vulnerable to stress), 5) openness (fantasy, aesthetics, feelings, actions, ideas, values).
- There was no difference in anxiety scoring between women who did and did not EB for 6 months.
- Depression scores during pregnancy were higher among women who did not EB for 6 months.
- Women who are extraverted have lower EB rates at 6 months.
- Women who are open and agreeable have higher EB rates at 6 months.
- Low agreeableness, low extraversion, high neuroticism, and high openness are associated with symptoms of anxiety and depression during pregnancy and postpartum.
See the Answer
Although personality as well as anxiety and depression are recognized as predictors for breastfeeding initiation, evidence of an association of these factors with 6 months' exclusive breastfeeding as recommended by the World Health Organization (WHO) is sparse.
The purpose of this study was to investigate the associations of personality and symptoms of anxiety and depression during and after pregnancy with meeting the WHO recommendation of 6 months' exclusive breastfeeding.
In their first trimester of pregnancy, 5784 pregnant women were enrolled in Dutch primary obstetric care centers and hospitals, of which 2927 completed the breastfeeding assessments 6 months postpartum. We performed logistic regression analyses to test the associations of “big five” personality traits (NEO Five Factor Inventory), anxiety (State-Trait Anxiety Inventory), and depression (Edinburgh Postnatal Depression Scale) symptom levels during pregnancy and postpartum with meeting the WHO recommendation of 6 months' exclusive breastfeeding.
Agreeableness (odds ratio [OR] = 1.18, P = .006) and openness (OR = 1.31, P < .001) were positively associated with meeting the WHO recommendation, whereas extraversion (OR = 0.83, P = .005) and neuroticism (OR = 1.18, P = .006) were negatively associated. After adjustment for both antenatal and postpartum symptom levels of anxiety and depression, the associations of the agreeableness, extraversion, and openness personality traits remained strong and statistically significant (P < .05).
Implications for Practice:
Patient-centered care should take personality into account in an effort to tailor interventions to optimize breastfeeding behavior.
Implications for Research:
In contrast to earlier findings, personality traits may be of greater importance than symptoms of anxiety and depression for meeting the WHO recommendation of 6 months' exclusive breastfeeding.
Decision-making about breastfeeding is complex, especially for mothers who are having difficulties, such as having an infant who won’t latch, low milk supply, or persistent breast pain. It has always amazed me how highly variable women are in their determination to ‘stick it out longer’. Some women are very patient and truly believe that their non-latching baby will eventually nurse, and others resign themselves readily to exclusive pumping. Personality is not the whole story here, since cultural, psychosocial, and medical considerations are also in play. However, further studies on the role of personality in breastfeeding duration might help us create more effective strategies to counsel mothers, so that they could reframe breastfeeding in a more hopeful and positive light.